Typical signs
- Start-up pain in the morning or after long sitting
- Tenderness and thickening 2–6 cm above the heel bone
- Pain directly at the heel insertion
- Symptoms improve briefly with warm-up, worse afterwards
- Lack of strength in single-leg heel raise or push-off
- Rehab after Achilles rupture – conservative or surgical
Background
Why the tendon complains
Load spikes
New shoes, speed work, jump training or a sudden volume jump overload the tendon – often with 24–48 h delayed reaction.
Not enough calf strength
Fewer than about 25 clean single-leg heel raises means too little capacity for running and jumping.
Tendons need load, not rest
Complete rest lowers capacity further. Progressive controlled loading is the therapy.
Insertion is different
At the insertion, deep stretch increases compression. Different exercises are required than for midportion tendinopathy.
Our approach
Your tendon build-up
We work with clear load stages and a pain traffic light: up to 3–4/10 during exercise is fine if the next day is not worse.
Step 1 · assessment
Determine tendon type
Midportion vs. insertion, calf strength test, jump test, review of training data and shoes.
Phase 1 · calm
Control pain
Isometrics, load management, heel lift if needed, shockwave therapy for stubborn cases.
Phase 2 · strength
Remodel the tendon
Heavy slow resistance or Alfredson protocol over 12 weeks with controlled progression.
Phase 3 · energy
Jump & run
Plyometric progression, running build-up, sport-specific loading and a maintenance programme.
Building blocks
What we work with
Shockwave Therapy
Radial – activates tissue regeneration in stubborn tendon problems.
Performance Lab
EMG, strength and jump diagnostics: we measure deficits instead of guessing.
Medical Equipment Training
Progressive strength work on medical devices – the lever for lasting capacity.
Manual Therapy
Joint and tissue techniques to quickly restore mobility and modulate pain.
Sports Physiotherapy
Pro-level return-to-sport – Bundesliga practice applied to your rehab.
Recovery Suite
Compression, cold and recovery support between training loads.
What we base this on
- Eccentric and heavy slow resistance training is the evidence-based first-line therapy (Alfredson protocol; Beyer et al., AJSM 2015).
- Radial shockwave therapy improves outcomes in treatment-resistant cases when combined with exercise (Rompe et al.).
- Single-leg heel raise capacity correlates with return to running and jumping sports.
FAQ